Incontinence

[Guest guest]

At 05:11 AM 10/29/00 -0600, Gesler wrote:

>iguanavet@... wrote:

>

> > Hi All,

> >

> > I was wondering if anyone else out there experiences bladder

> > incontinence that has been at least partially attributed to your

> > chiari.....

> > Dave

Dave, I reiterate what said. Kegel exercises are also appropriate

for men; here are male instructions (sent to the group as other men may

also have this problem!)

THE STEPS

1) To get in touch with your pelvic muscles, pretend you're in danger of

urinating or having a bowel movement but that you have to wait until you're

near a toilet. The muscles you squeeze to hold it in are your pelvic muscles.

2) To strengthen these muscles, start by holding and releasing them 15

times, twice a day. Don't hold the contraction -- just squeeze and let go.

You can do this unobserved almost anywhere -- while driving a car, reading

the paper, watching TV, during a meeting ...

3) Gradually increase the number of squeezes until you're up to 75, twice a

day. When you reach 75 at a sitting, instead of immediately releasing the

contraction, hold it for a count of three, and then relax and repeat.

4) Work up slowly to about 50 of these longer Kegels. Continue doing the

exercises for six weeks, alternating between the shorter and the longer Kegels.

A side effect of Kegel exercises for men is that it also improves the

quality of orgasms.

>Hi Dave,

>

> I have the opposite, my bladder or whatever tightens and I can't go.

>Sometimes, I have to go so bad but my body won't let me. I have to work

>on total relaxation and that doesn't always work either.

, I have this same problem. I have found two things that help - a

hot bath, and the tried and true method used with children - running the

faucet while trying to go. Because of logistics, I usually go for the

running water first.

The cramping that I get from this is horrible and quite painful. The

nervous structures between the bladder sphincter and the anal sphincter are

somehow linked (have never looked this up, only speaking from my own

experience), so I can get anal pain at the same time. Very annoying. It

feels like you have to have a bowel movement, but there is no reason to.

Here's a trivia quiz for the group (if you got this far...) How many

sphincter muscles are in the human body?

I hope that this was not too frank of a posting - but I figure... we are

all in this together, and I am not going to get embarrassed about anything.

Too much experience with doctors and hospitals for that to happen anymore! :-)

--

-sylvan

There are 5 sphincter muscles. Bladder, anal, stomach, and pupils.

[Guest guest]

Thought this might be helpful- if not, let me know and I wont do any

more. I have tried to keep it simple and in clear English. I saw

some posts on inco and thought if people better understood more

about it they could get better care and help.

Contents:

Basics: the anatomy of " down there " and what things do

Types of incontinence

How to diagnose incontinence

WHat about fibromyalgia?

Treatments and therapies

Things you can do to promote good urinary health

Basics:

In a woman, there are three opening between the legs:

the anus, which is on its own and

and the vagina and urethra. These are in the vulva. The area around

the vagina and from the anus to the urethral opening in the vulva is

called the perineum.

The urethra in a woman is about 1-3 inches long; in men it varies

but can be very long, and is usually no less than 10-12 inches. This

is why women are so much more prone to urinary tract infections-

they are more vulnerable because the opening to the bladder is

closer to the outside. The vulva tends to keep the area inside it

dark, moist- which is why women have a tendency towards yeast/thrush

infections.

The bladder sits on top of the pelvic floor muscles, which hold it

up. The urethra passes through the pelvic floor muscles, and in men,

through the prostate gland. In men, there is also an entry into the

urethra from the testicles. Fluid from the prostate and testicles

enters the urethra- but there is a one way valve so men can't pee

and pass semen at the same time. If the pelvic floor muscles are

weak, it weaken the ability to hold in urine and poo, and can cause

a prolapse- when (rarely)the bladder or (more commonly)

uterus " fall " and the uterus starts to come through the vaginal

opening- a prolapse uterus is not uncommon and can be repaired

surgically or with a pessary ring that can be fitted by a doctor or

specialist nurse.

Near the bottom of the bladder is an area called the trigone, where

the ureters (one on each side) bring urine from the kidneys. Ureters

carry clean urine from the kidneys, where it is made by filtering

out wastes and excess water from the blood. Some things are too big

to go into urine- like usually glucose and protein. These will have

to go into the intestine to get out, unless over time the kidneys

have become damaged or the concentration of these things in the

blood becomes too high. Some of the things the kidneys filter out

can cause stones to develop. A kidney stone is very painful- it

feels as if you are being cut open. They are rare, bt if you have

one, you will probably know about it!

Some illness can cause the ureters to back up; if urine back up into

the kidneys it can do damage. These conditions are usually

infection, adhesions from past surgery, pelvic inflammatory disease

(from past untreated pelvic infections), and endometriosis

(overgrowth of uterine tissue outside the uterus).

Most people make about 30 ml- two tablespoons- of urine an hour

unless they have a lot to drink. If you pass less than this, you may

not have enough fluid in you and this can be dangerous for your

general health. When the bladder has 300-400 mls in it, it starts to

stretch. This tells the special cells in it that it has fluid in it,

and that its getting full. Thats the signal to you that its time to

go. The bladder can hold nearly a litre- but that puts a lot of

stress on the sphinctre- the special muscle that forms the " cork " .

The pelvic floor muscle also helps hold the bladder closed. When the

skills you learned in potty training kick in, you can open the

bladder and let the fluid out.

Now onto incontinence.

Types of incontinence

There are five primary types of incontinence (inco).

1. Stress: This is the most common kind and the least worrisome to

your doctor because it is so common.

Symptoms: You pee when you do anything that stresses the muscles

that keeps the bladder from leaking or the pelvic floor: by

coughing, sneezing, standing or lifting, laughing

Risk or predisposing factors: Anything that has put pressure on or

weakened the muscles and pelvic floor, such as past or current

pregnancy, obesity, age, muscle wasting disease, medications that

relax muscles

Treatment: Pelvic floor exercises (kegel exercises), injections to

increase size of muscle, surgery to correct other factors such as a

prolapsed uterus, bladder training. You can get info on Kegels from

the internet, from the doctor'dmdithtrtu,rtg,

2. Urge

Symptoms: You can't hold the pee long enough to get to the toilet,

not because of how slow you walk but because of how fast the pee

moves! As soon as you think " Ohh, I need a pee " , you have. Stimulus

such as running water or putting the hand under a cold tap can be

disastrous.

Risk or predisposing factors: Infection, age, neurological problems,

irritable bladder

Treatment: Bladder training, medication.

3. Functional

Symptoms: If I could get to the loo, I wouldn't have a problem!

Risk or predisposing factors: Urinary system works fine. The rest of

you is the problem. You either can't walk fast enough, or can't

transfer onto the commode fast enough, or can't communicate to

someone else that you need help

Risk or predisposing factors: anything that impedes mobility,

movement or communication

Treatment: Fix or address the risk/predisposing factors

4. Reflexive or spinal

Symptoms: Pee just comes out- you don't even know.

Risk/predisposing factors: spinal cord injury/disease

Treatment: use of catheter

5. Overflow: this is most common in men, for whom it may be a sign

of prostate disease

Symptoms: You know you need to pee, and in fact you feel that way

most f the time- your bladder never really feels empty and you

dribble all the time. When you try to go, you don;t go enough- then

poof- the next thing you know, the wet knicker fairy has paid you a

visit.

Risk/ predisposing factors: Prostate trouble, infection, bladder

stones, neurogenic bladder, injury to the bladder

What may be one kind of incontinence can change to another type, for

example, stress incontinence can become reflexive inco if the person

has a stroke.

In FIBROMYALGIA:: when a person has FM they commonly get irritable

bladder syndrome: the bladder becomes hypersensitive to pressure and

triggers that it needs to empty before it is actually full. This

means that you go too often, and the bladder gets retrained to need

to pee even when it only has 30-100 mls in it The more often you

give in to the need to empty it, the more often it tirggers you need

to pee even if you don't. You need to retrain your bladder so that

you are in charge. When you feel the need to pee, hold the muscles

like you are holding in a pee (because you are!) and then distract

yourself. Try to only go every 2-3 hours (see bladder training

below). Medications like Ditropan/oxybutinin can help, and there are

others, too. Doing Kegel/ pelvic floor exercises can help.

Ways to help make things better

Pelvic floor retraining:

-Kegel exercises can improve, and even prevent, urinary

incontinence. Should be performed 30-80 times daily for at least 8

weeks, and should be continued for an indefinite period if possible-

usually in batches of 10-15. Its not hard nor does it take long. You

can find the exercises on the net or on a worksheet from your

doctor. These also help improve intimate " abilities " . Basically, you

squeeze your pelvic muscles together like you are trying to hold a

pee in- count to three, and let it go. Keep doing it. Doctors can

prescribe the use of weights or other internal devices to help make

the exercises more effective, such as electro stimulation or

biofeedback.

Bladder training: Hold the pee when you feel the need to and see if

the feeling subsides, and then try to pee only every two - three

hours at most, except at night when you pee the last thing before

you go to bed and the very first thing when you get up. If you wet

during the night, try to drink **Nothing** 2-3 hours before your

bedtime so that when you get to bedtime your bladder will have no

back up of fluids. Or, set the alarm for half an hour before you

suspect you do pee and go to the loo then. If you aren't sure, try

1:30 or 3:30. Use products to protect your bed and skin, and relax-

this is not abnormal, there is nothing to be ashamed of, and with

help it will get sorted out.

Medications:

- Oxybutynin (also called Ditropan) can help with urge incontinence

by working on the sphincter muscles

-Oestrogen, either by tablet or in a cream to the area, can help

post-menopaual women

- collagen injections into the sphincter to make it bulkier

What will they do if they think or I think I have incontinence?

1. They will ask you to keep a chart for at least two weeks. (more

on that below)

2. They will ask about symptoms and take both a personal and family

history

3. They may want to have a scan done of your bladder, either an

ultrasound or a bladder scan. One of the scans can use a

transvaginal probe- a probe that goes inside the vagina. Ask if the

test will use one; these tests are done usually at the hospital.

4. They may refer you to a specialist nurse or doctor

5. They may recommend or prescribe (UK) inco pads.

6. They will do/ recommend a gynaecological examination. Gynae

problems can affect the bladder and its work.

7. They will ask for a urine sample to do a dip stick test. They

stick in a strip with reagent pads that looks for different things.

To make sure there is no false positive for a UTI, make sure your

vulva is clean (white blood cells can build up if you have yeast,

are big, or if your skin ir irritated) by risning with water or with

whipes they can give you, and then pee in a cup which then gets

taken for testing. If there is debris in the urine, from paper or

from cells there for another reason, they might falsely find a UTI.

Charting incontinence:

Record every time you pee,

-and the quantity: small, medium, large, extra large amount

- the colour: clear, pale, yellow, amber, orange, brown, red- if you

see flecks of red, make sure to document it.

- the odour: ammonia, strong food odour, foul or fishy, none

if your urine is a colour other than yellow or amber or clear, think

of what you ate- anything with a strong pigment like beetroot?

Record every time you have damp or wet knickers

- the time

- how wet (small, med, large, drenched to the degree you needed to

change clothing)

- did you know or not know you passed water

Signs and symptoms of a UTI (urinary Tract Infection)

Most common: Frequency, urgency, burning

( you need to go often, you need to go NOW, and it burns when you

pass water)

Also: foul smelling urine (but remember that odour and colour of

urine can also come from food, and some foods, like asparagus, can

make the urine smell terrible)

Fever, pain from spasms in the area of the bladder

Sediment in urine (from leftover white blood cells)

Things that can make it look like you have a UTI when you dont:

-A vaginal infection like thrush/yeast- because it makes the area

red and sore, it hurts when you pee, and you pee alot because it

irritates on the general area, and because it can make it look like

there is sediment in the urine

- Bridal bladder- a very active love life like that on the first

honey moon night can make the same symptoms of UTI because of

irritation to the perineum (area " down there " )

Things you can do to promote good urinary health:

1, wear cotton knickers so the area " down there " can breathe!

Organisms like yeast /thrush enjoy dark, damp arm areas- keeping it

all of these makes it welcoming for nasty critters. If you are very

obese, use cotton flannels to keep skin from getting close to other

skin.

2, drink enough water (about 2 litres) and drink cranberry juice-

cranberry juice help keep the urine acidic

3, let your female areas clean themselves- using commercial feminine

hygiene products / douches can make more trouble than they solve

4, don't use soap there- again, irritation is not nice and can make

things worse

5,wipe from front to back or use a bidet- dont make it easy for

critters to get from the back

entrance

6, if you use baby wipes, use non-scented ones

7, Get treatment for yeast/thrush infections- there are good over-

the-counter medications

8, get regular Gynae exams

If you have incontinence:

Don't be ashamed. Its not uncommon, doesnt mean you are losing your

mind, and isnt because you aren't clean or anything like it.

Use the right inco product for you. There are many many different

ones. Biggest isnt always best!

Make sure you use a product to prevent the equivalent of urine

getting on your skin. Urine can damage skin.Vaseline, or any " nappy "

or diaper rash ointment can help.

Dont worry about odour- it only will smell if you dont keep

routinely clean. Spraying all kinds of feminine deodorants will only

cost you alot and contribute to skin breakdown.